对专注于 COVID-19 大流行的护理研究的思考

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The COVID-19 pandemic has consumed nursing for more than 2 years now. Nurses have been and remain at the heart of the response to the pandemic––nurses are central to preventative, curative and palliative activities associated with COVID-19, and have taken these roles on in addition to their usual roles. Nurses of all levels and career stages have responded to and been affected by the pandemic––from students of nursing, through to academic and executive nurses (Heilferty et al., 2021; Ion et al., 2021; Riddell et al., 2022). Nurse researchers have also been very responsive to the pandemic. Like many other nursing and health journals, the Journal of Advanced Nursing has received literally hundreds of manuscripts focused on the pandemic, and we have published more than 200 papers on the COVID-19 pandemic over the past 2 years. These papers have come from all over the world and have focused on many areas of interest, but the most dominant topic by far has been on the effects of the COVID-19 pandemic on the nursing workforce. Effects on the nursing workforce have been felt internationally––the hundreds of papers we have published shows that there is not an area of nursing or a geographical location that has escaped the effects of the pandemic.

Through the pages of the Journal of Advanced Nursing we have learned about many aspects of the pandemic and how it has been experienced all over the world. Nurse researchers were quick to scrutinize and synthesis the literature to ascertain the presenting signs and symptoms of adult hospitalized patients with COVID-19 at a time when still little was known about the virus (Keller et al., 2020). There has been considerable recognition of the needs of particular populations such as older adults and those living with chronic conditions (Rodrigues et al., 2022; Ryan & Meskell, 2022; Searby & Burr, 2021), as well as the effects of visitor restrictions in community and health settings (Rodney et al., 2021), and particularly on the effects and impacts of these restrictions on minority populations (Altman et al., 2021). Issues such as loneliness (Rodney et al., 2021), attitudes and views on vaccination (Burden et al., 2021) and health disparity (Jackson et al., 2021; James et al., 2021) have been raised and interrogated in relation to the COVID-19 pandemic.

The pandemic has had deleterious effects on nursing staff and been associated with uncertainty (Turgut et al., 2022), fear and emotional exhaustion (Sarabia-Cobo et al., 2021), psychological distress (Hamama et al., 2021) and burnout (Galanis et al., 2021; Manzano García & Ayala Calvo, 2021) in nurses. We have gained insights into the moral distress experienced by hospital nurses during the pandemic, and know that the causes of the distress were varied and included issues with availability of personal protective equipment (PPE), concerns about transmission of infection from work to home and providing care to patients dying alone (Foli et al., 2021; Lake et al., 2022; McCallum et al., 2021). Hospital nurses have reported experiencing withdrawal, anxiety and difficulty sleeping associated with the COVID-19 pandemic (Lake et al., 2022). Foli et al. (2021) provided detailed information about the psychological distress experienced by hospital nurses caring for patients with COVID-19. Respondents in this study described experiencing anxiety, depression, feeling unsupported, having to make tough decisions, dealing with intrusive thoughts, isolation from family and friends, increased use of substances and maladaptive coping associated with the pandemic (Foli et al., 2021). Hospital nurses reported feelings of betrayal associated with lack of adequate resources, and authors have highlighted a need to ensure appropriate support services for nurses experiencing mental health sequelae arising from the pandemic (Foli et al., 2021).

In addition to the challenges faced by hospital nurses (Foli et al., 2021; Hamama et al., 2021; Lake et al., 2022), Hoedl et al. (2022) describe nursing home staff having greater workloads, experiencing fear, uncertainty and increased stress and striving to meet the needs of residents and family members who were more stressed because of the pandemic (also Sarabia-Cobo et al., 2021). These authors go on to highlight the additional support needs that nursing home staff have because of the COVID-19 pandemic (Hoedl et al., 2022; Sarabia-Cobo et al., 2021). Nurses working in primary care also reported experiencing anxiety and stress, as well as acts of abuse and violence directed towards them (Ashley et al., 2021).

However, regardless of the challenges and stressors presented by the pandemic, Ke et al. (2021) found that most frontline nurses demonstrated strong professional commitment and were prepared to continue to work during the pandemic. These authors also suggest some strategies that are important to nurses' willingness to work, including provision of emotional support, recognition of and reward for the nursing contribution, ensuring the availability of appropriate resources, including PPE, access to appropriate training and social support, and coordinating appropriate and realistic working hours.

Despite the pressures brought about by the pandemic, nurses have shown a willingness to innovate and change their practices. The pandemic created changes in the ways nurses could work and interact with patients and consumers and was a catalyst for nurses to develop new and inventive ways to deliver services (Gardiner & MacLellan, 2021). Skill mix and staffing models were changed to build capacity as a response to the demands of the pandemic (Endicott et al., 2022), and where possible, services adopted various forms of remote working and telehealth, which was seen to be useful and effective in some ways but problematic in others (Hughes et al., 2022). Nurses identified issues with delivering alcohol and drug services through telehealth, though this modality was seen as being successful as an adjunct service to people living in regional or remote locations or with those consumers who had a preference for telehealth (Searby & Burr, 2021).

Patient safety has remained a central concern for nurse researchers during the pandemic (Andel et al., 2022). Nurses have been quick to recognize where there have been unintended and deleterious outcomes to patients and to take steps to better understand and mitigate the issues. Istanboulian et al. (2022) recognized communication impairments in patients treated with invasive mechanical ventilation in the intensive care unit during the COVID-19 pandemic and undertook a study to explore the barriers and facilitators for supporting optimal communication in this context. Nurses have recognized the particular needs of people with chronic and underlying health needs during the pandemic and have modified approaches to care to ensure that patients and consumers still had access to the best possible care that could be delivered during the pandemic (Ryan & Meskell, 2022; Searby & Burr, 2021). Similarly, administrators and academic nurses have revised processes and their ways of working to be optimally responsive during the pandemic, in the constraints that were faced (Ion et al., 2021; Riddell et al., 2022).

Despite the proliferation of papers on the pandemic, many questions remain. There are several areas that have had relatively little attention, or that require further scrutiny. The longer term effects of the pandemic on the nursing workforce are yet to be fully understood and this includes effects on the emergent workforce, as newly graduated nurses have experienced various forms of educational disruption, and are entering a more stressed environment. Changes to skill mix and staffing models and metrics were enacted during the pandemic, and it is yet to be seen whether these changes will be retained or if previous models and metrics will be restored, in either original or modified ways. We know that many clinical services were curtailed or restricted during the very acute stages of the pandemic because of the need for staff and resources to be redirected to the pandemic. This resulted in some suspension and modification of services, and large scale redeployment of nurses into different clinical areas. There has not yet been many empirical studies of the effects of this redeployment on patient care and outcomes for patients or on the nurses who were redeployed. Undoubtedly this strategy will be scrutinized and future research findings will be very useful in considering the ways that redeployment can be used in future events.

We know that some people are now living with long COVID, and future research will help us to better understand and respond to the needs of these people and their families. We also know that during very acute stages of the pandemic, not only were there high death rates, there were also restrictions to events such as funerals and because of this, many people were deprived of access to their usual rituals around loss and death. We are yet to fully understand the effects of this, on grief and on rates of complicated grief.

The pandemic is not yet over and the final effects of the pandemic will not be known for several years. Despite the extent and demands of the COVID-19 pandemic, nurses have and continue to collaborate and share information to address the challenges presented by the pandemic (Ion et al., 2021; Riddell et al., 2022), and this has resulted in the ability of nurses and nursing to effectively respond to a dynamic and rapidly changing situation. The empirical knowledge that nurses have produced and shared through the pages of the journal will help us to better respond to future public health crises. Over the coming years, the global nursing community will continue to deal with the aftermath of the pandemic and continue to generate the knowledge that will help us through the next phases of recovery from the pandemic. Nurses will continue to contribute to the evidence base for nursing and health care in the context of disaster and public health emergencies.

全文翻译（仅供参考）

COVID-19 大流行已经消耗了 2 年多的护理时间。护士一直是并且仍然是应对大流行病的核心——护士是与 COVID-19 相关的预防、治疗和姑息性活动的核心，除了通常的角色外，他们还承担了这些角色。各个级别和职业阶段的护士都对这一流行病做出了反应并受到了影响——从护理专业的学生到学术和行政护士（Heilferty 等人，2021 年；Ion 等人，2021 年；Riddell 等人，2022 年） ）。护士研究人员对这一流行病也非常敏感。与许多其他护理和健康期刊一样，《高级护理杂志》已经收到了数百篇专注于大流行的手稿，在过去 2 年中，我们发表了 200 多篇关于 COVID-19 大流行的论文。这些论文来自世界各地，集中在许多感兴趣的领域，但迄今为止最主要的话题是关于 COVID-19 大流行对护理人员的影响。国际上都感受到了对护理人员的影响——我们发表的数百篇论文表明，没有一个护理领域或一个地理位置能够逃脱大流行的影响。

通过高级护理杂志的页面，我们了解了大流行的许多方面以及它在世界各地的经历。在对该病毒知之甚少的时候，护士研究人员迅速审查和综合文献，以确定成年 COVID-19 住院患者的症状和体征（Keller 等人，2020 年）。老年人和慢性病患者等特定人群的需求已得到广泛认可（Rodrigues 等人，2022 年；Ryan 和 Meskell，2022 年；Searby 和 Burr，2021 年），以及游客限制的影响在社区和卫生环境中（Rodney 等人，2021 年），特别是关于这些限制对少数民族人口的影响和影响（Altman 等人，2021 年）。孤独感（Rodney 等人，2021 年）、对疫苗接种的态度和观点（Burden 等人，2021 年）和健康差异（Jackson 等人，2021 年；James 等人，2021 年）等问题已经被提出和审问。与 COVID-19 大流行的关系。

大流行对护理人员产生了有害影响，并与不确定性（Turgut 等人，2022 年）、恐惧和情绪衰竭（Sarabia-Cobo 等人，2021 年）、心理困扰（Hamama 等人，2021 年）和倦怠有关（Galanis 等人，2021 年；Manzano García 和 Ayala Calvo，2021 年）在护士中。我们深入了解了医院护士在大流行期间所经历的道德困扰，并知道造成这种困扰的原因多种多样，包括个人防护设备 (PPE) 的可用性问题、对从工作场所传播到家中的感染的担忧以及提供照顾孤独死的病人（Foli 等人，2021 年；Lake 等人，2022 年; 麦卡勒姆等人，2021 年）。据报道，医院护士经历了与 COVID-19 大流行相关的戒断、焦虑和睡眠困难（Lake 等人，2022 年）。Foli 等人。（2021 年）提供了有关护理 COVID-19 患者的医院护士所经历的心理困扰的详细信息。本研究中的受访者描述了经历焦虑、抑郁、感到不受支持、不得不做出艰难的决定、处理侵入性想法、与家人和朋友隔离、物质使用增加以及与大流行相关的适应不良的应对方式（Foli 等，2021）。医院护士报告了与缺乏足够资源相关的背叛感，作者强调需要确保为经历大流行引起的心理健康后遗症的护士提供适当的支持服务（Foli 等人，2021 年）。

除了医院护士面临的挑战（Foli 等人，2021 年；Hamama 等人，2021 年；Lake 等人，2022 年），Hoedl 等人。( 2022 ) 描述了养老院工作人员的工作量更大、经历恐惧、不确定性和压力增加，并努力满足因大流行而承受更大压力的居民和家庭成员的需求（也是 Sarabia-Cobo 等人，2021 年）。这些作者继续强调养老院工作人员因 COVID-19 大流行而需要的额外支持（Hoedl 等人，2022 年；Sarabia-Cobo 等人，2021 年））。从事初级保健工作的护士也报告说他们经历过焦虑和压力，以及针对他们的虐待和暴力行为（Ashley 等人，2021 年）。

然而，不管大流行带来的挑战和压力如何，Ke 等人。（2021 年）发现，大多数一线护士表现出强烈的专业承诺，并准备在大流行期间继续工作。这些作者还提出了一些对护士工作意愿很重要的策略，包括提供情感支持、对护理贡献的认可和奖励、确保提供适当的资源，包括 PPE、获得适当的培训和社会支持，以及协调适当和现实的工作时间。

尽管大流行带来了压力，但护士们仍表现出创新和改变做法的意愿。大流行改变了护士与患者和消费者的工作和互动方式，并成为护士开发新的和创造性的服务提供方式的催化剂（Gardiner & MacLellan，  2021 年）。改变技能组合和人员配备模式以建立能力以应对大流行的需求（Endicott 等人，2022 年），并且在可能的情况下，服务采用了各种形式的远程工作和远程医疗，这被认为是有用和有效的在某些方面，但在其他方面存在问题（Hughes 等人，2022）。护士们发现了通过远程医疗提供酒精和药物服务的问题，尽管这种方式被视为成功地为居住在偏远地区或偏远地区的人们或那些偏爱远程医疗的消费者提供了辅助服务（Searby & Burr，2021 年）。

在大流行期间，患者安全一直是护士研究人员关注的核心问题（Andel 等人，2022 年）。护士们很快就发现了哪些地方对患者造成了意外和有害的结果，并采取措施更好地理解和缓解这些问题。伊斯坦布利安等人。( 2022) 认识到在 COVID-19 大流行期间在重症监护室接受侵入性机械通气治疗的患者的沟通障碍，并进行了一项研究，以探索在这种情况下支持最佳沟通的障碍和促进因素。护士已经认识到大流行期间有慢性和潜在健康需求的人的特殊需求，并修改了护理方法，以确保患者和消费者在大流行期间仍然能够获得可能提供的最佳护理（Ryan & Meskell，2022；Searby & Burr，  2021 年）。同样，管理人员和学术护士已经修改了流程和他们的工作方式，以便在大流行期间在面临的限制条件下做出最佳响应（Ion et al., 2021 ; Riddell 等人，2022 年）。

尽管有关大流行的论文激增，但仍然存在许多问题。有几个领域受到的关注相对较少，或者需要进一步审查。大流行对护理人员的长期影响尚待充分了解，这包括对新兴劳动力的影响，因为新毕业的护士经历了各种形式的教育中断，并进入了压力更大的环境。大流行期间对技能组合和人员配备模型和指标进行了更改，这些更改是否会保留，或者是否会以原始或修改的方式恢复以前的模型和指标，还有待观察。我们知道，由于需要将人员和资源重新分配给大流行，许多临床服务在大流行的非常严重的阶段被削减或限制。这导致一些服务的暂停和修改，以及护士大规模重新部署到不同的临床领域。关于这种重新部署对患者护理和患者结局或对重新部署护士的影响的实证研究还没有很多。毫无疑问，这一策略将受到审查，未来的研究结果将非常有助于考虑在未来事件中使用重新部署的方式。

我们知道有些人现在长期感染新冠病毒，未来的研究将帮助我们更好地了解和响应这些人及其家人的需求。我们还知道，在大流行的非常严重的阶段，不仅死亡率很高，而且葬礼等活动也受到限制，因此，许多人被剥夺了围绕失去和死亡进行通常的仪式的机会。我们尚未完全了解这对悲伤和复杂悲伤率的影响。

大流行尚未结束，大流行的最终影响将在几年内未知。尽管 COVID-19 大流行的范围和需求很大，但护士已经并将继续合作和分享信息，以应对大流行带来的挑战（Ion 等人，  2021 年；Riddell 等人，  2022 年）)，这使护士和护理人员能够有效地应对动态和快速变化的情况。护士通过期刊页面产生和分享的经验知识将帮助我们更好地应对未来的公共卫生危机。在接下来的几年里，全球护理界将继续应对大流行的后果，并继续产生有助于我们从大流行中恢复的下一阶段的知识。在灾难和公共卫生紧急情况下，护士将继续为护理和医疗保健的证据基础做出贡献。

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